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Dr. Bob is Robert Hsiung, MD,
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Posted by Elizabeth on April 19, 1999, at 2:50:40
In reply to Re: Refractory depression--naltrexone, posted by Jim on April 17, 1999, at 12:35:50
Hi Jim. I did ask my doctor about ReVia, and he, as well as the consultant who originally recommended the buprenorphine, didn't seem to think it was such a hot idea. I would be interested to find out if anyone has a good idea of how opioid agonist responders fare on the pure antagonists, though.
To anyone who's tried naltrexone, what sort of side effects did it have (and do you happen to know of any other common ones)? Given that I'm probably doomed to polypharmacy, I'd like to keep that sort of thing to a minimum.
Back to Jim - your symptoms sound pretty much dissimilar to mine, which is discouraging. I have pretty much classic episodic melancholia, and panic disorder (which seems pretty easy to treat and as such isn't a big concern for me these days). No significant atypical features except for occasional bouts of social phobia, and as noted, no impulse-related symptoms. (In particular, despite having experimented with drugs and alcohol quite a lot in college, I've never had problems with addiction.) I've had depressions since adolescence (now nearly 23), and they've grown closer together and more severe over time. When depressed I tend to have early-morning insomnia (where I wake up feeling like sh*t), pronounced feelings of self-reproach and guilty ruminations, loss of pleasure, motivation, and interest, fatigue and feelings of being "slowed down," and appetite loss. I've also been battling chronic pain and sleep problems for quite a while.
I was under the impression that naltrexone is rather long-acting, actually, and that q.o.d. dosing suffices for many. I could be thinking of something else, though.
Posted by Jim on April 19, 1999, at 4:39:41
In reply to Re: Refractory depression--naltrexone, posted by Elizabeth on April 19, 1999, at 2:50:40
Hi Elizabeth,
I don't want to sound like a naltrexone pusher--I'm having enough of a time trying to get it stabilized with me... (I'm apparently as supersensitive to it as to SSRIs, which is a disappointment.) I will say, however, that I have tended to really "enjoy" the effects of prescribed opiates in the past (e.g., I absolutely savored the demerol from my last tooth extraction); this is one of the reasons I was originally interested in buprenex, too. I agree that our symptoms are not totally similar, especially when it comes to food cravings, but I've also had anxiety-panic and definitely social phobia (along with a couple major depressive episodes). Naltrexone duration is supposedly a function of dosage (hence the various dosing schedules), but it seems that its course of antagonism at receptors is not fully understood yet.
Best, Jim> Hi Jim. I did ask my doctor about ReVia, and he, as well as the consultant who originally recommended the buprenorphine, didn't seem to think it was such a hot idea. I would be interested to find out if anyone has a good idea of how opioid agonist responders fare on the pure antagonists, though.
>
> To anyone who's tried naltrexone, what sort of side effects did it have (and do you happen to know of any other common ones)? Given that I'm probably doomed to polypharmacy, I'd like to keep that sort of thing to a minimum.
>
> Back to Jim - your symptoms sound pretty much dissimilar to mine, which is discouraging. I have pretty much classic episodic melancholia, and panic disorder (which seems pretty easy to treat and as such isn't a big concern for me these days). No significant atypical features except for occasional bouts of social phobia, and as noted, no impulse-related symptoms. (In particular, despite having experimented with drugs and alcohol quite a lot in college, I've never had problems with addiction.) I've had depressions since adolescence (now nearly 23), and they've grown closer together and more severe over time. When depressed I tend to have early-morning insomnia (where I wake up feeling like sh*t), pronounced feelings of self-reproach and guilty ruminations, loss of pleasure, motivation, and interest, fatigue and feelings of being "slowed down," and appetite loss. I've also been battling chronic pain and sleep problems for quite a while.
>
> I was under the impression that naltrexone is rather long-acting, actually, and that q.o.d. dosing suffices for many. I could be thinking of something else, though.
Posted by paul on April 19, 1999, at 10:01:37
In reply to Re: Refractory depression--naltrexone, posted by Jim on April 19, 1999, at 4:39:41
Please put me on your "mailing list" for info on opioid agonists/antagonists in the treatment of depression, dysthymia, etc. It seems that if opioid agonists, whose primary mechanism of action is typically associated with (short-term) euphoria (often listed as a "side effect" in medical texts), then it should follow that antagonists would have no mood-elevating effects whatsoever.
I am fascinated with the seemingly paradoxical effects of antagonists, I would be interested in joining this discussion. I'm also interested in the effects of mixed agonists/antagonists.
Thanks.
Posted by paul on April 19, 1999, at 10:22:43
In reply to naltrexone, posted by paul on April 19, 1999, at 10:01:37
> Please put me on your "mailing list" for info on opioid agonists/antagonists in the treatment of depression, dysthymia, etc. It seems that if opioid agonists, whose primary mechanism of action is typically associated with (short-term) euphoria (often listed as a "side effect" in medical texts), then it should follow that antagonists would have no mood-elevating effects whatsoever.
>
> I am fascinated with the seemingly paradoxical effects of antagonists, I would be interested in joining this discussion. I'm also interested in the effects of mixed agonists/antagonists.
>
> Thanks.I posted the above message before I read the hypotheses/theories that preceded it. Very interesting. Is the idea of naltrexone as an adjunct to SSRI's new in the psychiatric community? In other words, is the average psychiatrist familiar with such treatment? Also, is this augmentation particularly useful in those with a propensity to abuse (oral only) opioids, such as hydrocodone? I take Zoloft and while I don't have a serious problem, I do have an affinity for things that attach to my opioid receptors.
Posted by Victoria on April 19, 1999, at 15:06:55
In reply to Re: Refractory depression--naltrexone, posted by Elizabeth on April 19, 1999, at 2:50:40
Elizabeth, Your symptoms sound very much like mine (except no panic disorder). The reference you made to chronic pain and sleep problems makes me think of my recent diagnosis of fibromyalgia (did we exchange posts on this a while ago)? Anyway, I'm currently doing much better on a combination of trazadone and serzone at night, and fairly agressive thyroid and hormone replacement (estrogen and testosterone--I'm older than you are). The more I learn about both depression and fibromyalgia, the more I believe they are related problems with brain chemistry. You might want to take a look at "Betrayal By the Brain" by Jay Goldstein, MD. One interesting overlap is that he claims to have a lot of success with fibromyalgia with neurontin and pindolol (among other things, he's got about 30 meds he works with). And lately I've been seeing more about both of those drugs as anti-depressants or augmenters of anti-depressants. I'm going to see Dr. Goldstein next month, so if I get good results, I'll let you know.
> Hi Jim. I did ask my doctor about ReVia, and he, as well as the consultant who originally recommended the buprenorphine, didn't seem to think it was such a hot idea. I would be interested to find out if anyone has a good idea of how opioid agonist responders fare on the pure antagonists, though.
>
> To anyone who's tried naltrexone, what sort of side effects did it have (and do you happen to know of any other common ones)? Given that I'm probably doomed to polypharmacy, I'd like to keep that sort of thing to a minimum.
>
> Back to Jim - your symptoms sound pretty much dissimilar to mine, which is discouraging. I have pretty much classic episodic melancholia, and panic disorder (which seems pretty easy to treat and as such isn't a big concern for me these days). No significant atypical features except for occasional bouts of social phobia, and as noted, no impulse-related symptoms. (In particular, despite having experimented with drugs and alcohol quite a lot in college, I've never had problems with addiction.) I've had depressions since adolescence (now nearly 23), and they've grown closer together and more severe over time. When depressed I tend to have early-morning insomnia (where I wake up feeling like sh*t), pronounced feelings of self-reproach and guilty ruminations, loss of pleasure, motivation, and interest, fatigue and feelings of being "slowed down," and appetite loss. I've also been battling chronic pain and sleep problems for quite a while.
>
> I was under the impression that naltrexone is rather long-acting, actually, and that q.o.d. dosing suffices for many. I could be thinking of something else, though.
Posted by Elizabeth on April 20, 1999, at 3:29:56
In reply to naltrexone, posted by paul on April 19, 1999, at 10:01:37
> Please put me on your "mailing list" for info on opioid agonists/antagonists in the treatment of depression, dysthymia, etc
If anyone is interested in actually forming such a mailing list, I'd be happy to maintain it. I think it's a wonderful idea, and it would be a good way of bringing together a number of people who have experiences in this area.
-elizabeth
Posted by Elizabeth on April 20, 1999, at 3:40:33
In reply to Re: Refractory depression--Elizabeth, posted by Victoria on April 19, 1999, at 15:06:55
Victoria, we did have that discussion about fibro, and I don't rememeber what I felt about it. But yeah, it's been in the back of my mind for a while (I recently made a "what is it?" post here).
My doctor did recommend thyroid augmentation. Right now I'm taking Parnate (30mg) and Ambien (20mg qhs) with prn's of Xanax and buprenorphine. (Trazodone as a sedative didn't work for me - kept having to increase the dose.)
Do you think that estrogens and/or testosterones could help someone my age?
>"Betrayal By the Brain" by Jay Goldstein, MD
I'm laughing now because I often use the expression, "I feel like my brain has betrayed me." I will check this one out. I've been looking for good references (not too "pop psychology," but not too technical) on this for a while. Where is he?
Neurontin is something I've tried. It made me very fuzzy and oversedated, and I gained weight. I don't think it helped with the pain, but it might have. It was actually suggested for the panic disorder (which may or may not "really" be epilepsy.)
Anyway, thanks for the info. It looks like it will be useful - I'll talk to my psychopharmacologist about it (I see him tomorrow).
Posted by Wayne R. on April 20, 1999, at 6:01:22
In reply to Re: naltrexone, posted by Elizabeth on April 20, 1999, at 3:29:56
> If anyone is interested in actually forming such a mailing list, I'd be happy to maintain it.
I would welcome such a list. I feel like the Naltrexone poster boy and would love to hear about the results of others. Wayne
Posted by pej-Phil on April 20, 1999, at 6:48:37
In reply to Re: naltrexone mailing list, posted by Wayne R. on April 20, 1999, at 6:01:22
> > If anyone is interested in actually forming such a mailing list, I'd be happy to maintain it.
>
> I would welcome such a list. I feel like the Naltrexone poster boy and would love to hear about the results of others. Wayne>>I'd be interested in receiving info on Naltrexone...sign me up! Thanks..Phil
Posted by Annie on April 20, 1999, at 12:48:24
In reply to Re: naltrexone, posted by Elizabeth on April 20, 1999, at 3:29:56
I'd like to be on the list too. Annie
> > Please put me on your "mailing list" for info on opioid agonists/antagonists in the treatment of depression, dysthymia, etc
>
> If anyone is interested in actually forming such a mailing list, I'd be happy to maintain it. I think it's a wonderful idea, and it would be a good way of bringing together a number of people who have experiences in this area.
>
> -elizabeth
Posted by Elizabeth on April 20, 1999, at 17:28:53
In reply to Re: naltrexone, posted by Annie on April 20, 1999, at 12:48:24
I've created the list...I wanted to make it broader than just about naltrexone. Also, it'll be limited to discussion of the use of opioids in psychiatry with an emphasis on uses *other* than for substance-related disorders (mainly, depression). No humor posts, virus warnings, etc. And no flaming!
If you asked to be on the list, you should be getting an invitation email sometime soonish.
Posted by JohnB. on April 22, 1999, at 1:32:05
In reply to opioid agonist/antagonist discussion mailing list, posted by Elizabeth on April 20, 1999, at 17:28:53
I'd love to be included in the opiate receptor action list you are forming. Been very interesting!
Thanks
JohnB.
Posted by Nick on April 23, 1999, at 12:13:32
In reply to Re: Dysthymia/Bipolar Depression (Elaine), posted by Nancy on April 12, 1999, at 16:40:45
>
> ***NO KIDDING!!! I went through hell and high water to get T-three and T4!!!!!!!!!!! In just the first 7 days of taking T-three, you will begin to feel more energetic. ??i have to spell out the word "three" because my keyboard just lost it's mind...the numeral three isn't working at the moment(33333...see?)...oh, well.
>
> Anyway, (oh, i love to tell my stories....Thank You!) my pdoc and gp were totally against using thyroid augmentation BECAUSE MY TEST RESULT CAME BACK "NORMAL". I finally began asking where on the range of "normal" was I???? GET THIS: Doctors say that your thyroid levels are normal, even when those levels are in the "low end of normal". Which, by the way, IS NOT sufficient thyroid level for treatment refractory patients!
>
> The pdoc who had read literature (even after graduating from med school) important for prescribing drugs for severly treatment resistive bipolar patients (like me), was the pdoc who ended my 18 months of agonizing and totally disabling depression.
>
>
> ****Dosage begins at 0.05mgs/ A.M./ empty stomach. An ultra sensitive thyroid blood test is done two weeks later. Increase dosage by 0.05mgs, as before, until both T3three and T4 levels are in the upper-quartile of the "normal" range.
>
>
> Side Efeects??? be careful that you don't drink enough caffienated drinks to cause a pounding heart...you may have some flushing (turning a little pinkish) of your skin, rather than the pale sickly color of the skin when your thyroid is "low normal"...oh, also, you may feel a lot better than you ever have since this awful depression began!
>
>
> Thanks for posting Nancy - I'll feel a bit more confident in prescribingKR
Nick
>
Posted by Nick on April 23, 1999, at 12:16:34
In reply to Re: opioid agonist/antagonist discussion mailing list, posted by JohnB. on April 22, 1999, at 1:32:05
> I'd love to be included in the opiate receptor action list you are forming. Been very interesting!
>
> Thanks
> JohnB.Me too!
Nick
Posted by Michael on May 10, 1999, at 17:54:16
In reply to Re: naltrexone mailing list, posted by Wayne R. on April 20, 1999, at 6:01:22
> > If anyone is interested in actually forming such a mailing list, I'd be happy to maintain it.
>
> I would welcome such a list. I feel like the Naltrexone poster boy and would love to hear about the results of others. WayneHey there Wayne,
Remember me? I wrote a thread to one of your posts back in March. I finally got my doctor to give me the Revia (naltrexone) perscription in order to augment my Prozac and Trazadone combo used to treat my OCD. I've never felt as good as I did the first few months of starting Prozac. Aside from the sexual side effects, agitation, and the headaches, I felt like I was "King of the world". Well, hopefully in a couple of weeks with the naltrexone I'll be feeling good again. I'll keep you posted. Any words of wisdom you have would be greatly appreciated. Thanks!!
Mike
Posted by PattyG on May 10, 1999, at 20:04:44
In reply to opioid agonist/antagonist discussion mailing list, posted by Elizabeth on April 20, 1999, at 17:28:53
May I please be added to this list? Thank you!
Posted by Wayne R. on May 11, 1999, at 5:32:09
In reply to Re: naltrexone mailing list, posted by Michael on May 10, 1999, at 17:54:16
Hey Mike!
May you become the permanent “King of the world”!! I guess my only words of wisdom are to start slowly. Work the dosage up very gradually to allow your system to adjust. God, I would just love to have others duplicate the success I have had. Keep me posted and send me specific questions if they come up.
Wayne
Posted by Michael on May 13, 1999, at 13:09:37
In reply to Re: naltrexone mailing list, posted by Wayne R. on May 11, 1999, at 5:32:09
> Hey Mike!
>
> May you become the permanent “King of the world”!! I guess my only words of wisdom are to start slowly. Work the dosage up very gradually to allow your system to adjust. God, I would just love to have others duplicate the success I have had. Keep me posted and send me specific questions if they come up.
>
> WayneHey Wayne,
I thought I was starting low at only a quarter of a 50mg pill. The first day was okay, but the second day I felt nauseous, dizzy and tired. I also had a pretty bad headache. I skipped taking it today and I still feel lousy. I know it stays in your sytem for like 72 hours just like Prozac. I'm just wondering if what I'm experiencing sounds normal to you and should I just take a quarter pill every third day or some other protocol. I've tried so many things, with so many bad reactions I'm really getting pretty fed up. Please advise me as to what you think I should do. I hope to read back from you soon.
Mike
Posted by Wayne R. on May 13, 1999, at 14:56:35
In reply to Not doing so good., posted by Michael on May 13, 1999, at 13:09:37
> Hey Wayne,
>
I'm just wondering if what I'm experiencing sounds normal to you and should I just take a quarter pill every third day or some other protocol.
> Mike
Mike, Like most meds I am not sure there is a "normal" since we are all so different. As for me I broke a 50 mg tablet into 7 pieces and took the smallest piece first, etc. That worked well for me but if you are especially sensitive you might go with tiny fragments for several days until things even out and then go to a slightly larger fragment. Wishing you the best... Wayne
Posted by saintjames on May 13, 1999, at 15:05:01
In reply to Not doing so good., posted by Michael on May 13, 1999, at 13:09:37
> > Hey Mike!
> >
> > May you become the permanent “King of the world”!! I guess my only words of wisdom are to start slowly. Work the dosage up very gradually to allow your system to adjust. God, I would just love to have others duplicate the success I have had. Keep me posted and send me specific questions if they come up.
> > Wayne
>
> Hey Wayne,
>
> I thought I was starting low at only a quarter of a 50mg pill. The first day was okay, but the second day I felt nauseous, dizzy and tired. I also had a pretty bad headache. I skipped taking it today and I still feel lousy. I know it stays in your sytem for like 72 hours just like Prozac. I'm just wondering if what I'm experiencing sounds normal to you and should I just take a quarter pill every third day or some other protocol. I've tried so many things, with so many bad reactions I'm really getting pretty fed up. Please advise me as to what you think I should do. I hope to read back from you soon.
>
> MikeJames here....
Prozac lasts far longer than 72 hrs. Side effects are always going to be bad the first week. For me, unless they are life threatning I have always sit them out to see if they lessen and the med works.
james
Posted by Jim on May 14, 1999, at 6:15:07
In reply to Not doing so good., posted by Michael on May 13, 1999, at 13:09:37
Jim here, former would-be naltrexone poster-boy (see last months posts). I agree with Wayne that the key may to start with VERY small doses--I overshot even by taking an eighth of a pill for the first few days: nightmares, insomnia, etc. After curiously feeling terrific a few days after stopping the naltrexone, I restarted and did much better on very small fractional doses (i.e. 1 or 2 mg a day, or even every other day--the kind of doses you would expect only to have an effect on opiate abusers, but had a profound effect on me). I reluctantly discontinued it recently because it was giving me the same sort of idiosyncratic side-effects I get with SSRIs, but low dosages seemed to work well for a while, especially for cutting back the food cravings that have now all returned with a vengence! In sum, I think the 25 or 50mg dosage may be too high for many people, at least to start with.
Good luck,
Jim
> Hey Wayne,
>
> I thought I was starting low at only a quarter of a 50mg pill. The first day was okay, but the second day I felt nauseous, dizzy and tired. I also had a pretty bad headache. I skipped taking it today and I still feel lousy. I know it stays in your sytem for like 72 hours just like Prozac. I'm just wondering if what I'm experiencing sounds normal to you and should I just take a quarter pill every third day or some other protocol. I've tried so many things, with so many bad reactions I'm really getting pretty fed up. Please advise me as to what you think I should do. I hope to read back from you soon.
>
> Mike
Posted by PattyG on May 14, 1999, at 19:26:33
In reply to Re: Not doing so good., posted by Jim on May 14, 1999, at 6:15:07
Glad to hear (well, not really "glad") that others are having same experience as my husband. Poor soul was really nauseated and dizzy the first day on 25 mg. Thankfully, he cut it in half! We're trying the "break it into quite a few pieces" process and starting over. Anyone with experience know if eventually your system becomes accilamated?
Posted by Michael on May 17, 1999, at 14:30:49
In reply to Re: Not doing so good., posted by PattyG on May 14, 1999, at 19:26:33
> Glad to hear (well, not really "glad") that others are having same experience as my husband. Poor soul was really nauseated and dizzy the first day on 25 mg. Thankfully, he cut it in half! We're trying the "break it into quite a few pieces" process and starting over. Anyone with experience know if eventually your system becomes accilamated?
Please keep me posted!! I've given up for the time being. I just felt so horrible for about 3 days after taking the second dose that I'm afraid to try again. I'm not doing all that great in general but at least I don't feel as bad as I did. I've experimented so much lately that I just need some time to relax. I need a little stability before I try anything again.
Posted by PattyG on May 18, 1999, at 11:27:27
In reply to Re: Not doing so good., posted by Michael on May 17, 1999, at 14:30:49
Sorry you're having the same problems. I've broken the tablet into fractions of fractions and he still complains of headaches, some nausea, and loose bowels. Even took a dose with two aspirin and started taking it at bedtime, but to no avail. Also, anyone know if Naltrexone is the generic for Revia (the way our insurance worked, it would appear to be.) If so, wondered if that could be part of the problem? Anyone know? And.........how about Kudzuroot? It's supposed to be the "natural" Naltrexone - anyone try that yet?
Posted by chuck on May 18, 1999, at 12:15:50
In reply to opioid agonist/antagonist discussion mailing list, posted by Elizabeth on April 20, 1999, at 17:28:53
>I would love to get on this mailing list---->started taking naltrexone about 4 weeks ago (with Zoloft, for last four years) with some results, though I'm not altogether sure what they are; that is, if if has 'boosted' my SSRI, it has done so only slightly. thanks.
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